title: Smart consultation for musculoskeletal trauma: accuracy of using smart phones for fracture diagnosis.
abstract: BACKGROUND
  Musculoskeletal trauma occupies a significant proportion of the daily workload of most Emergency and Radiology departments. The diagnosis and management of patients with musculoskeletal trauma often require assessment of radiographs along with clinical assessment. With the advent of smart phones we hypothesised that they could be used as a means of smarter communication, particularly for the transfer of radiographic images between healthcare professionals.
  
  
  METHODS
  We performed a cross sectional study using thirty radiographs each of the distal radius, ankle and hip. The study was approved by Ethics Committee and all data were anonymized in accordance to Caldicott guidelines and data protection act 1998. Photographs of radiographs were taken using an iphone camera and sent to three independent Orthopaedic Registrars via Multimedia messaging service (MMS). Each Registrar independently assessed these images on their smart phone display in their own time and recorded the specific diagnosis along with the classification of fractures and specific treatment plan. The accuracy of diagnosis on smart phone was measured against the radiology report; and inter observer agreement was assessed among registrars for classification and treatment plan.
  
  
  RESULTS
  The overall accuracy of fracture diagnosis was 97.7% with sensitivity of 100% and specificity of 94.4%. The inter observer agreement analysis showed kappa (k) values of 0.67, 0.67 and 0.71 for classification of wrist, ankle and hip fractures respectively showing substantial agreement while kappa values for management plan were 0.65, 0.88 and 0.65 for the three fractures respectively showing substantial to near perfect agreement.
  
  
  CONCLUSIONS
  This study suggests that smart phone can be used as a safe and accurate tool for skeletal trauma consultation among oncall doctors and can help reduce the waiting time in emergency departments.
authors.affiliation: Department of Orthopaedics, Sligo General Hospital, Sligo, Ireland. Electronic address: drgoharabbas@hotmail.com.
authors.forename: G A
authors.initials: GA
authors.lastname: Naqvi
authors.affiliation: Department of Orthopaedics, Sligo General Hospital, Sligo, Ireland.
authors.forename: M
authors.initials: M
authors.lastname: Daly
authors.affiliation: Department of Orthopaedics, Sligo General Hospital, Sligo, Ireland.
authors.forename: A
authors.initials: A
authors.lastname: Dawood
authors.affiliation: Department of Orthopaedics, Sligo General Hospital, Sligo, Ireland.
authors.forename: A
authors.initials: A
authors.lastname: Kurkuri
authors.affiliation: Department of Orthopaedics, Sligo General Hospital, Sligo, Ireland.
authors.forename: S
authors.initials: S
authors.lastname: Kutty
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D064386:Ankle Fractures / Q000000981:diagnostic imaging*; D040421:Cell Phone; D003430:Cross-Sectional Studies; D006620:Hip Fractures / Q000000981:diagnostic imaging*; D006801:Humans; D008875:Middle Aged; D015588:Observer Variation; D009985:Orthopedics / Q000379:methods*; D010781:Photography; D011859:Radiography; D011885:Radius Fractures / Q000000981:diagnostic imaging*; D012017:Referral and Consultation; D012680:Sensitivity and Specificity; D055815:Young Adult
keywords: Accuracy; Diagnosis; Fracture; Smart phone